Angioplasty vs. Atherectomy

Peripheral artery disease (PAD) is a condition caused by narrowed or blocked arteries in the legs, often due to plaque buildup. It can lead to leg pain, mobility issues, and even severe complications like ulcers or amputation if left untreated. Two common minimally invasive procedures for PAD treatment are angioplasty and atherectomy. While both aim to restore blood flow, they work differently and have distinct advantages.

Angioplasty involves using a catheter with an inflatable balloon to open up the narrowed arteries, making it effective for many patients. Atherectomy, on the other hand, involves removing the plaque buildup from the artery walls, which can be particularly beneficial in certain cases where plaque may be more complex.

Understanding the differences between these minimally invasive procedures is essential for patients to work with their healthcare providers to select the most appropriate treatment for managing PAD effectively. The right approach can significantly improve quality of life and reduce the risk of further complications.

What is Angioplasty?

Angioplasty is a procedure that uses a balloon catheter to open narrowed or blocked arteries in the legs. It is one of the most frequently used minimally invasive techniques for PAD and is often combined with stent placement to keep the artery open.

Ideal Candidates for Angioplasty

If you are suffering from one or more of the following PAD symptoms:

• Chronic leg pain (even when resting)
• Cramping in your calf muscles
• Changes in the color of your legs
• Leg numbness, tingling, or weakness
• Limitations to your daily activities
• Feeling pain in the legs or feet without activity 
• Wounds or sores on your legs, feet, or toes that won’t heal

How Angioplasty Works

1. A catheter is inserted into a blood vessel, usually through the groin or leg.
2. The catheter is guided to the blocked artery using X-ray imaging techniques.
3. A small balloon at the tip of the catheter is inflated to push the plaque against the artery walls, widening the vessel.
4. A stent may be placed to maintain the artery’s openness.
5. The balloon is deflated and removed, restoring blood flow to the leg.

Benefits of Angioplasty for PAD

• Minimally invasive with a short recovery time
• No hospital stay required 
• Decreased risk of complications and no scarring
• Effective in treating moderate arterial blockages in the legs
• Can quickly relieve symptoms such as leg pain (claudication)
• Often combined with stenting for long-term results

Angioplasty Recovery

The angioplasty procedure may last 30-90 minutes. You’ll be monitored post-procedure and typically discharged the same day. Avoid heavy lifting for 48 hours; light walking is encouraged. Medications may be prescribed to prevent blood clotting, and lifestyle adjustments (e.g., diet, exercise, quitting smoking) are important for long-term success.

What is an Atherectomy?

Atherectomy removes plaque buildup from artery walls using a catheter with a rotating blade or laser, restoring blood flow to the legs. It is particularly useful for PAD patients with heavily calcified plaque that is not easily treated with an angioplasty or stent. 

Ideal Candidates for Atherectomy

If you are experiencing one or more of the following PAD symptoms: 

• Muscle pain and numbness in the feet or legs
• Calf pain while walking that goes away with rest
• Sores or wounds on the legs or feet that won’t heal
• Poor circulation in the legs or feet 
• Leg and foot, and/or toe discoloration
• Weakness in the legs, feet, or toes
• Legs, feet, or toes feeling cold

How Atherectomy Works

1. A catheter equipped with a cutting device, laser, or rotating burr is inserted into the artery.
2. The device removes or breaks down the plaque, improving blood flow.
3. In some cases, angioplasty and stenting may be performed afterward to open the artery further.
4. The removed plaque is either collected in the catheter or broken down into tiny particles that the body naturally clears.

Types of Atherectomy Used in PAD

Depending on the severity of your PAD, one of four types of atherectomies may be used to remove the plaque from your artery:

• Directional Atherectomy: Uses a small, rotating blade to shave off any plaque.
• Rotational Atherectomy: A high-speed burr grinds the plaque into fine particles.
• Laser Atherectomy: A laser beam vaporizes plaque.
• Orbital Atherectomy: A diamond-coated rotating device sands down plaque for easier removal.

Benefits of Atherectomy for PAD

• Same day procedure with no hospital stay
• Minimally invasive with quicker recovery times
• Improved circulation and restored blood flow
• No major incision or scarring 
• Effective for heavily calcified plaque in the legs
• Can be used when angioplasty and stenting alone may not be enough

Atherectomy Recovery

The atherectomy procedure typically takes  1-2 hours. You’ll be monitored post-procedure and discharged the same day. Light walking is encouraged, but avoid heavy lifting and strenuous activity for 1-2 weeks. Lifestyle changes (regular exercising, healthy diet, avoiding smoking) and routine checkups with your doctor can help ensure long-term results. 

Differences Between Angioplasty and Atherectomy for PAD

Choosing the Right Treatment for PAD

The choice between angioplasty and atherectomy for PAD depends on several factors, including the severity of the blockage, type of plaque, and patient-specific considerations such as overall health and existing conditions.

• Angioplasty is preferred when the blockage is relatively straightforward, and a stent can effectively maintain blood flow.
• Atherectomy is recommended when the blockage is heavily calcified, complex, or resistant to balloon angioplasty.
• Combination Treatment: In some cases, atherectomy is performed first to remove plaque, followed by angioplasty and stenting to optimize results.

Get Expert PAD Treatment at American Endovascular

At American Endovascular, we specialize in minimally invasive PAD treatments, such as atherectomy and angioplasty. Our affiliated vascular specialists can help determine which procedure is right for you. For expert diagnosis and PAD treatment, call us or schedule an appointment online today.